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1.
J Appl Oral Sci ; 28: e20190023, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31800871

RESUMO

When exposure of the pulp to external environment occurs, reparative dentinogenesis can be induced by direct pulp capping to maintain pulp tissue vitality and function. These clinical situations require the use of materials that induce dentin repair and, subsequently, formation of a mineralized tissue. OBJECTIVE: This work aims to assess the effect of tricalcium silicate cements and mineral trioxide aggregate cements, including repairing dentin formation and inflammatory reactions over time after pulp exposure in Wistar rats. METHODOLOGY: These two biomaterials were compared with positive control groups (open cavity with pulp tissue exposure) and negative control groups (no intervention). The evaluations were performed in three stages; three, seven and twenty-one days, and consisted of an imaging (nuclear medicine) and histological evaluation (H&E staining, immunohistochemistry and Alizarin Red S). RESULTS: The therapeutic effect of these biomaterials was confirmed. Nuclear medicine evaluation demonstrated that the uptake of 99mTc-Hydroxymethylene diphosphonate (HMDP) showed no significant differences between the different experimental groups and the control, revealing the non-occurrence of differences in the phosphocalcium metabolism. The histological study demonstrated that in mineral trioxide aggregate therapies, the presence of moderate inflammatory infiltration was found after three days, decreasing during follow-ups. The formation of mineralized tissue was only verified at 21 days of follow-up. The tricalcium silicate therapies demonstrated the presence of a slight inflammatory infiltration on the third day, increasing throughout the follow-up. The formation of mineralized tissue was observed in the seventh follow-up day, increasing over time. CONCLUSIONS: The mineral trioxide aggregate (WhiteProRoot®MTA) and tricalcium silicate (Biodentine™) present slight and reversible inflammatory signs in the pulp tissue, with the formation of mineralized tissue. However, the exacerbated induction of mineralized tissue formation with the tricalcium silicate biomaterial may lead to the formation of pulp calcifications.


Assuntos
Compostos de Alumínio/farmacologia , Materiais Biocompatíveis/farmacologia , Compostos de Cálcio/farmacologia , Polpa Dentária/efeitos dos fármacos , Dentina/efeitos dos fármacos , Dentinogênese/efeitos dos fármacos , Óxidos/farmacologia , Silicatos/farmacologia , Animais , Polpa Dentária/patologia , Capeamento da Polpa Dentária/métodos , Exposição da Polpa Dentária/tratamento farmacológico , Exposição da Polpa Dentária/patologia , Combinação de Medicamentos , Proteínas da Matriz Extracelular/análise , Imuno-Histoquímica , Masculino , Imagem Molecular/métodos , Odontoblastos/efeitos dos fármacos , Fosfoproteínas/análise , Agentes de Capeamento da Polpa Dentária e Pulpectomia/farmacologia , Pulpite/tratamento farmacológico , Pulpite/patologia , Distribuição Aleatória , Ratos Wistar , Reprodutibilidade dos Testes , Sialoglicoproteínas/análise , Fatores de Tempo
2.
BMC Oral Health ; 19(1): 227, 2019 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-31647004

RESUMO

BACKGROUND: Pulpotomy is one of the most widely used methods in preserving vital pulp in teeth, which is of great significance in achieving continue root formation in immature permanent teeth suffering from dental caries or trauma. The aim of this meta-analysis and systemic review is to synthesize the available evidences to compare different pulpotomy dressing agents for pulpotomy treatment in immature permanent teeth. METHODS: Electronic databases including MEDLINE (via Pubmed), EMBASE, the Cochrane library (CENTRAL) and the clinicaltrials.gov database were searched. The references of all included articles or relevant reviews were cross-checked. Only randomized controlled trials (RCTs) comparing two or more pulp dressing agent in permanent teeth with open apex would be included. Also, the studies should have at least 6 months of follow-up, report clinical and radiographic success in detail and publish in English. RESULTS: Five RCTs were included for a systematic review, and all of them had a high risk of bias. There is little difference in success rate between mineral trioxide aggregate (MTA) and calcium hydroxide (CH) at 6-month follow-up (risk ratio (RR) 1; 95% confidence interval (CI) 0.94 to 1.06) and 12-month follow-up (RR 1.04; 95% CI 0.96 to 1.13). There is no difference between MTA versus platelet-rich fibrin and MTA versus calcium-enriched mixture (CEM). There is only weak evidence of increased success rate in using MTA and triple antibiotic paste (TAP) rather than abscess remedy. CONCLUSIONS: Based on the present evidence, similar success rates with MTA were found between the dressing agents CH, CEM, RPF and TAP as pulpotomy-dressing agents in the treatment of immature permanent teeth. More high-quality RCTs are needed in this field in future studies.


Assuntos
Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Dentição Permanente , Pulpotomia/métodos , Silicatos/uso terapêutico , Cárie Dentária/terapia , Capeamento da Polpa Dentária/métodos , Exposição da Polpa Dentária/terapia , Combinação de Medicamentos , Humanos , Óxidos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
3.
Acta Odontol Scand ; 77(7): 541-551, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31146622

RESUMO

Objective: Coronal pulpotomies were recently re-investigated as an alternative to root canal treatment in vital permanent teeth. General dentists may be interested in knowing how to perform full pulpotomy, in particular in face of difficult endodontic cases of vital teeth. Material and methods: A systematic review was undertaken on the PubMed and Cochrane databases in order to determine which procedure should be applied for pulp capping and coronal restoration in routine dental practice. Fifty-three publications were included and allocated to one of two methodological categories: histological and clinical studies. Results and conclusions: There is no evidence to recommend one single procedure for full pulpotomy in vital permanent teeth that can be indicated for different pulpal diagnoses which differ greatly in terms of the inflammation process from healthy teeth to irreversible pulpitis. For each clinical case, all actions aiming to prevent pre-operative contamination, to control per-operative infection and to achieve a complete seal above the radicular pulp sections are unavoidable steps that should be complied with. Reproducing procedures adopted in high quality trials could insure high success rates.


Assuntos
Capeamento da Polpa Dentária/métodos , Dentição Permanente , Pulpite , Pulpotomia/métodos , Exposição da Polpa Dentária , Humanos , Silicatos
4.
J Int Med Res ; 47(6): 2381-2393, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30991868

RESUMO

OBJECTIVE: To evaluate dentist-related factors associated with the use of vital pulp therapy (VPT) for the treatment of pulp exposures in permanent teeth. METHODS: This survey-based study sent an online questionnaire to collect data on the demographics of the respondents, the use of VPT and the choice of materials for VPT, to all members of the Society of Endodontology of Guangdong, China. RESULTS: A total 183 of 380 members responded (48.2%). The majority (89.6%; 164 of 183) had performed direct pulp capping (DPC) while 55.2% (101 of 183) had performed partial pulpotomy (PP) at least once. The most-cited reason for not performing VPT was unfamiliarity with the technique. Mineral trioxide aggregate was the most commonly used material for both DPC (67.1%; 110 of 164) and PP (73.3%; 74 of 101). Endodontists, compared with general practitioners, preferred to perform DPC and chose calcium silicate materials (CSMs) for VPT (odds ratios 5.81 and 8.07, respectively). DPC and CSMs for VPT were also favoured more by respondents who had practised for > 5 years. Senior respondents were more likely to use PP. CONCLUSIONS: Speciality, years of practise and age of dentists influenced the decision making and the choice of materials for VPT. Continuing education is essential to promote the clinical use of VPT.


Assuntos
Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Capeamento da Polpa Dentária/métodos , Doenças da Polpa Dentária/terapia , Odontólogos/estatística & dados numéricos , Óxidos/uso terapêutico , Pulpotomia/métodos , Silicatos/uso terapêutico , Adulto , China/epidemiologia , Doenças da Polpa Dentária/epidemiologia , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Inquéritos e Questionários
5.
Clin Oral Investig ; 23(12): 4289-4299, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30864114

RESUMO

OBJECTIVES: To histologically evaluate the morphology of the newly formed mineralized tissue and of the adjacent cells, in intact human teeth subjected to mechanical pulp exposure and capping with a fast-setting mineral trioxide aggregate (RetroMTA). MATERIALS AND METHODS: Seven caries-free third molars from three adults were subjected to pulp exposure, direct capping with RetroMTA, and restoration with a composite resin. Seven months later, the teeth were clinically and radiographically evaluated, extracted, and subjected to histological processing and evaluation. RESULTS: All teeth were clinically and radiographically inconspicuous and showed no presence of severe inflammatory reactions. Bacteria were absent in all teeth. All cases exhibited some degree of mineralized tissue in the area of exposure to varying extent. This newly formed mineralized tissue was mostly atubular and did not display the features of regular dentine in any of the cases. No cells exhibiting the features of odontoblasts or odontoblast-like cells were observed. Instead, the cells exhibited a flat or cuboidal shape, resembling fibroblasts. CONCLUSIONS: When the exposed pulps were directly capped with RetroMTA, the new calcified hard tissue was not "regular dentine," and did not seem to be the product of genuine odontoblast differentiation. These results suggest that the formation of calcified tissues after direct pulp capping with RetroMTA may be more appropriately regarded as a reparative process than as a genuine regeneration response. CLINICAL RELEVANCE: This is the first histological study on humans showing that regular dentine was not regenerated when a bioactive pulp-capping material (RetroMTA) was placed over exposed pulp tissue. TRIAL REGISTRATION: NCT03631511.


Assuntos
Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Capeamento da Polpa Dentária/métodos , Polpa Dentária/efeitos dos fármacos , Agentes de Capeamento da Polpa Dentária e Pulpectomia/uso terapêutico , Silicatos/uso terapêutico , Adulto , Compostos de Alumínio/química , Compostos de Cálcio/química , Exposição da Polpa Dentária/terapia , Dentina Secundária/efeitos dos fármacos , Dentina Secundária/patologia , Combinação de Medicamentos , Humanos , Óxidos/química , Silicatos/química
6.
Niger J Clin Pract ; 22(1): 117-124, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30666030

RESUMO

Objective: The aim of this in-vivo study was to evaluate the long-term clinical survival of different deep dentin caries treatment options. Materials and Methods: : In total, 391 patients with at least one permanent tooth with clinically diagnosed deep dentin caries were inspected. Two hundred and fourteen patients were examined at recall visits. Inclusion criteria were teeth with deep caries lesions with pulp vitality but absence of spontaneous pain and periapical alterations. The subjects received either stepwise removal (SWR), complete caries removal (CCR), or direct pulp capping (DPC). The radiological and clinical exams were performed after a mean observation time of 62 months. Success was defined as pulp sensitivity to vitality test and absence of periapical lesions as well as a clinical symptom. Data were statistically analyzed using Kaplan-Meier and log-rank (Mantel-Cox) tests (α = 0.05). Results: Of the total 214 patients evaluated, 126 received SWR, 88 received CCR, and 67 received DPC treatment. One hundred and twenty-seven restorations were amalgam and 141 were composite. The mean observation period was 62 months. Survival rates were 85.7%, 90.9%, and 59.7% for SWR, CCR, and DPC, respectively (P = 0.001). Success rates of amalgam restorations (86.6%) were similar to composite restorations (83%), and both were found to be successful (P = 0.401). Conclusion: SWR treatment should be considered to preserve pulp vitality of deep dentin lesions instead of CCR or DPC. Clinical Relevance: SWR method for deep dentin caries management had acceptable results over 5 years.


Assuntos
Cárie Dentária/terapia , Preparo da Cavidade Dentária/métodos , Capeamento da Polpa Dentária/métodos , Restauração Dentária Permanente/métodos , Dentina/patologia , Adulto , Cárie Dentária/diagnóstico por imagem , Cárie Dentária/patologia , Materiais Dentários , Polpa Dentária/diagnóstico por imagem , Polpa Dentária/patologia , Polpa Dentária/fisiologia , Exposição da Polpa Dentária/patologia , Exposição da Polpa Dentária/prevenção & controle , Dentina/diagnóstico por imagem , Dentição Permanente , Feminino , Humanos , Masculino , Tratamento do Canal Radicular , Resultado do Tratamento
7.
J Investig Clin Dent ; 10(1): e12380, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30525301

RESUMO

AIM: The aim of the present study was to develop a bovine pericardium biomembrane (BPB) and to evaluate pulp response in vivo. METHODS: A double-layer bovine BPB/chitosan was manufactured, and the porous chitosan side was coated with calcium hydroxide. The microstructure of the matrices was evaluated with electron microscopy. To test pulp response, cavities were prepared on the occlusal surface of Wistar rats' mandibular left first molars and capped with matrices, followed by appropriate adhesives/composite restorations. The animals were divided into three groups: group 1, calcium hydroxide alone; group 2, BPB without calcium hydroxide; and group 3, BPB coated with calcium hydroxide. Specimens were processed and histologically evaluated at 7, 14, and 30 days, postoperatively. RESULTS: Electron microscopy showed porous chitosan surface and a cohesive calcium hydroxide layer. Histological analysis showed that groups 1 and 3 had mild odontoblast layer disorganization, but normal pulp tissue appearance at 7, 14, and 30 days. At the same time points, group 2 showed a loss of general pulp tissue, pulp necrosis, and periapical abscess in some teeth. CONCLUSION: Coated bovine pericardium-based biomembranes resulted in favorable outcomes in cases of pulp exposure after a 30-day observation period, and might protect against injuries caused by adhesive systems and composites.


Assuntos
Hidróxido de Cálcio/uso terapêutico , Capeamento da Polpa Dentária/métodos , Membranas/química , Pericárdio , Tratamento do Canal Radicular/métodos , Animais , Hidróxido de Cálcio/efeitos adversos , Bovinos , Quitosana/química , Resinas Compostas/efeitos adversos , Cimentos Dentários , Polpa Dentária/patologia , Necrose da Polpa Dentária/patologia , Restauração Dentária Permanente/métodos , Masculino , Teste de Materiais , Modelos Animais , Dente Molar/patologia , Abscesso Periapical/patologia , Ratos , Ratos Wistar , Cimentos de Resina/efeitos adversos , Propriedades de Superfície , Fatores de Tempo
8.
Clin Oral Investig ; 23(3): 1271-1280, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29987635

RESUMO

OBJECTIVES: To find out which management methods are preferred by dentists in Finland for a deep carious lesion or a pulp exposed during carious tissue removal in adult patients. MATERIALS AND METHODS: An electronic questionnaire consisting of 25 questions was sent to 1000 randomly sampled dentists in Finland. The response rate was 32%. RESULTS: Less invasive excavation strategies (stepwise or selective removal) were preferred by 64% for an asymptomatic deep lesion, while 34% chose nonselective removal to hard dentine. In the presence of an asymptomatic pulpal exposure, vital pulp therapy was preferred, as 71% of the respondents chose direct pulp capping (DPC) or partial pulpotomy, compared to root canal treatment (26%). Mineral trioxide aggregate (MTA) and calcium hydroxide-based materials were both chosen by 40% for vital pulp therapy. In the management of a deep carious lesion, less invasive excavation strategies were significantly associated with having clinical guidelines vs. no guidelines at the practice [odds ratio (OR) 3.5, confidence interval (CI) 1.4-9.0]. MTA was favored over other DPC materials significantly more often by those who had attended continuing education courses during the last 3 years (OR 2.8, CI 1.2-6.5). CONCLUSIONS: Less invasive management strategies have been adopted into clinical practice by the majority of dentists in Finland. There is a need to encourage the use of MTA in the case of a pulpal exposure. CLINICAL RELEVANCE: The results of this study can be utilized in continuing education, to raise awareness of management strategies supported by present scientific evidence.


Assuntos
Cárie Dentária/terapia , Capeamento da Polpa Dentária/métodos , Polpa Dentária , Pulpotomia , Adulto , Compostos de Alumínio , Compostos de Cálcio , Hidróxido de Cálcio , Odontólogos , Combinação de Medicamentos , Feminino , Finlândia , Humanos , Masculino , Óxidos , Padrões de Prática Odontológica , Tratamento do Canal Radicular , Silicatos , Inquéritos e Questionários
9.
J Contemp Dent Pract ; 19(9): 1065-1071, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30287705

RESUMO

AIM: The aim of the present in vivo study was to compare efficacy of light-cured resin-modified glass ionomer liner, Vitrebond™ (3M ESPE) with Dycal® (Dentsply) on the healing of pulpal tissue in the event of a direct iatrogenic pulpal exposure. MATERIALS AND METHODS: Experimental group consisted of Vitrebond™ (3M ESPE) resin-modified glass ionomer liner, and Vitremer™ (3M ESPE) resin-modified glass ionomer cement (GIC) in comparison with the control group of Dycal® (Dentsply) as liner and Poly F® (Dentsply) dental cement. Class V cavities were prepared in 32 sound premolars that were scheduled for orthodontic extraction, and the exposures were capped according to groups. Five teeth from each group were extracted under local anesthesia after an interval of 24 hours, 35 and 60 days, and evaluated for inflammation, fibrotic changes, formation of reparative dentin and bacterial examination. RESULTS: The present study did not show any statistically significant difference between two groups in terms of inflammation, fibrosis, reparative dentin formation, and bacterial examination. CONCLUSION: This study shows that Vitrebond™ (3M ESPE) light-cured resin-modified glass ionomer liner can be used as an alternative to calcium hydroxide as a direct pulp capping material. CLINICAL SIGNIFICANCE: Light-cured resin-modified glass ionomer liner can be an alternative for the calcium hydroxide-based liner for capping iatrogenic pulp exposures.


Assuntos
Resinas Acrílicas , Hidróxido de Cálcio , Resinas Compostas , Forramento da Cavidade Dentária , Capeamento da Polpa Dentária/métodos , Exposição da Polpa Dentária/terapia , Cimentos de Ionômeros de Vidro , Minerais , Poliuretanos , Agentes de Capeamento da Polpa Dentária e Pulpectomia , Exposição da Polpa Dentária/fisiopatologia , Humanos , Doença Iatrogênica , Cicatrização
10.
J Endod ; 44(11): 1603-1609, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30292451

RESUMO

INTRODUCTION: Mineral trioxide aggregate (MTA) has been used in pulp capping of cariously exposed mature permanent teeth with promising results. The search for alternative materials that seal better and set faster than MTA and do not stain is ongoing. Biodentine (Septodont, St Maur-des-Fossés, France) exhibits these advantages but has not been tested yet for a prolonged duration in mature teeth. This study aimed to evaluate the clinical performance of Biodentine and white MTA (Angelus, Londrina, Brazil) in cariously exposed mature permanent teeth. METHODS: This was a prospective longitudinal randomized controlled study of 68 vital permanent teeth with deep caries. Patients were randomly allocated into 2 study arms: Biodentine and MTA. Teeth were assessed clinically and radiographically before the procedure. Caries were excavated under local anesthesia; hemostasis was achieved after pulp exposure using sodium hypochlorite and capped with Biodentine or MTA. Clinical and radiographic follow-ups were performed by a blinded calibrated evaluator after 6 months and 1, 2, and 3 years. RESULTS: There were no significant differences in the overall success rate between Biodentine and MTA; it was 93.3% (Biodentine = 93.1% and MTA = 93.5%) at 6 months. The overall success rate increased to 96.2% (Biodentine = 96.0% and MTA = 100%) at 1 year and to 100% at 2 years. At the 3-year follow-up, it decreased to 93.8% (Biodentine = 91.7% and MTA = 96.0%). CONCLUSIONS: Biodentine and MTA have favorable and comparable success rates when used as direct pulp capping or pulpotomy material in permanent mature teeth with carious exposure. The remaining tooth structure and durability of coronal restoration might affect significantly the long-term success of vital pulp therapy.


Assuntos
Compostos de Alumínio/administração & dosagem , Compostos de Cálcio/administração & dosagem , Óxidos/administração & dosagem , Agentes de Capeamento da Polpa Dentária e Pulpectomia , Silicatos/administração & dosagem , Adolescente , Adulto , Capeamento da Polpa Dentária/métodos , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
11.
Eur Arch Paediatr Dent ; 19(5): 297-309, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30187263

RESUMO

INTRODUCTION: Carious or traumatised teeth with a normal pulp status or with reversible pulpitis need an indirect or direct pulp capping procedure to keep the pulp vital. AIM: To evaluate the clinical outcome of both interventions for treating vital primary teeth. STUDY DESIGN: Two reviewers on Pubmed and ISI Web of Science performed a comprehensive literature review of publications from 1966 until December 2017. Among PubMed abstracts, publications were selected according to the following criteria: prospective clinical study, correct indication for the performed treatment, and clear definition of clinical and/or radiographic success criteria. The strict selection criteria limited the amount of randomised controlled trials (RCT) or controlled clinical trials (CT); especially for "indirect pulp therapy", "direct pulp capping" and the number of RCTs was limited. CONCLUSIONS: Based on a systematic review (20 controlled clinical studies or randomised controlled clinical studies), the following statements can be given: Due to the opportunity of tissue repair, indirect pulp treatment can be an acceptable procedure for reversible pulp inflammation. The use of adhesives for indirect pulp capping in a single-visit procedure after gentle caries removal can be recommended. Successful pulp capping is possible under defined conditions (symptom-free tooth, disinfection of pulp exposures, Class-I cavity) and appropriate sealing of the cavity with an effective dentine seal being a conditio sine qua non. There is maximum evidence for the use of disinfecting solutions prior to pulp capping and Dycal as pulp capping material. Longer follow-up periods, more clinical studies, comparable conditions, and clear definitions of evaluation criteria are needed to confirm the results of endodontic treatment in primary teeth.


Assuntos
Materiais Dentários , Capeamento da Polpa Dentária/métodos , Dente Decíduo , Adesivos , Hidróxido de Cálcio , Cárie Dentária/terapia , Polpa Dentária , Desinfecção , Humanos , Minerais , Traumatismos Dentários/terapia
12.
Sci Rep ; 8(1): 10690, 2018 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-30013085

RESUMO

Dentin is primarily composed of hydroxyapatite crystals within a rich organic matrix. The organic matrix comprises collagenous structural components, within which a variety of bioactive molecules are sequestered. During caries progression, dentin is degraded by acids and enzymes derived from various sources, which can release bioactive molecules with potential reparative activity towards the dentin-pulp complex. While these molecules' repair activities in other tissues are already known, their biological effects are unclear in relation to degradation events during disease in the dentin-pulp complex. This study was undertaken to investigate the effects of dentin matrix components (DMCs) that are partially digested by matrix metalloproteinases (MMPs) in vitro and in vivo during wound healing of the dentin-pulp complex. DMCs were initially isolated from healthy dentin and treated with recombinant MMPs. Subsequently, their effects on the behaviour of primary pulp cells were investigated in vitro and in vivo. Digested DMCs modulated a range of pulp cell functions in vitro. In addition, DMCs partially digested with MMP-20 stimulated tertiary dentin formation in vivo, which exhibited a more regular tubular structure than that induced by treatment with other MMPs. Our results indicate that MMP-20 may be especially effective in stimulating wound healing of the dentin-pulp complex.


Assuntos
Cárie Dentária/terapia , Capeamento da Polpa Dentária/métodos , Dentina/metabolismo , Dentinogênese , Metaloproteinase 20 da Matriz/metabolismo , Adolescente , Adulto , Animais , Células Cultivadas , Cárie Dentária/patologia , Polpa Dentária/citologia , Polpa Dentária/patologia , Polpa Dentária/fisiologia , Dentina/química , Dentina/citologia , Dentina/patologia , Modelos Animais de Doenças , Feminino , Humanos , Masculino , Cultura Primária de Células , Agentes de Capeamento da Polpa Dentária e Pulpectomia/metabolismo , Ratos , Ratos Wistar , Cicatrização/fisiologia , Adulto Jovem
13.
Indian J Dent Res ; 29(3): 268-274, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29900907

RESUMO

Introduction: Treatment of mechanical exposure of the pulp during caries excavation presents a clinical challenge. In this case series of 15 patients, with a follow-up period of over a year, the outcome of direct pulp capping with Biodentine (septodont) after mechanical pulp exposure was assessed. Aim of Study: The aim of this study is to evaluate the outcome of direct pulp capping with Biodentine in deeply carious teeth when pulp was mechanically exposed during caries excavation and cavity preparation. Vital pulps exposed during caries excavation in molar teeth were treated with 3% sodium hypochlorite for 2 min. If adequate hemostasis was achieved, the pulp tissue was capped with Biodentine, which covered the entire pulpal floor. This was followed by the placement of a layer of resin-modified glass ionomer cement and a final layer of composite resin (Filtek Z350-3M) to complete the restoration. The patients were recalled periodically and evaluated for any evidence of pulpal/periapical pathology. Results: In the follow-up period that ranged from 12 to 24 months, all teeth were asymptomatic. Conclusion: Biodentine appears to be a suitable material for direct pulp capping under clinical conditions. However, long-term follow-up studies and controlled trials involving a large sample size are warranted.


Assuntos
Compostos de Cálcio/uso terapêutico , Cárie Dentária/terapia , Preparo da Cavidade Dentária/efeitos adversos , Capeamento da Polpa Dentária/métodos , Exposição da Polpa Dentária/etiologia , Exposição da Polpa Dentária/terapia , Agentes de Capeamento da Polpa Dentária e Pulpectomia/uso terapêutico , Silicatos/uso terapêutico , Adolescente , Adulto , Resinas Compostas , Feminino , Humanos , Masculino , Dente Molar , Resultado do Tratamento
14.
Eur Arch Paediatr Dent ; 19(3): 197-203, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29767382

RESUMO

AIM: This study was to compare the success of resin-modified Portland cement-based material (TheraCal) with MTA in direct pulp capping (DPC) of primary molars. METHODS: Symmetrical bilateral primary molars (92) from 46 healthy subjects aged 5-7 years were included in this split-mouth randomised clinical trial. DPC for small non-contaminated pulp exposures using either TheraCal or MTA were randomly performed in symmetrical molars. Thereafter, teeth were restored with amalgam. Clinical and radiographic evaluations were performed at 6 and 12 month follow-ups. Data were analysed using Chi square test at a significance level of 0.05. RESULTS: At the final follow-up session 74 teeth were available. After 12 months, the overall success rates for MTA and TheraCal were 94.5 and 91.8%, respectively. The difference between outcomes of the two groups was not statistically significant (P > 0.05). CONCLUSION: Within the limitations of the current study, radiographic and clinical findings revealed that TheraCal exhibited a comparable outcome to MTA in DPC of primary molars after 12 months.


Assuntos
Compostos de Alumínio , Compostos de Cálcio , Capeamento da Polpa Dentária/métodos , Óxidos , Agentes de Capeamento da Polpa Dentária e Pulpectomia , Silicatos , Criança , Pré-Escolar , Combinação de Medicamentos , Humanos , Dente Molar , Cimentos de Resina , Cimento de Silicato , Dente Decíduo
15.
Int Endod J ; 51(11): 1187-1195, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29679496

RESUMO

AIM: To explore the expression profile of CD45+/pro-collagen I+ fibrocytes in intact dental pulps as well as during wound healing in adult dental pulp tissue. METHODOLOGY: A total of 16 healthy permanent teeth were obtained from young patients (18 to 25 years) undergoing orthodontic treatment. Routine pulp capping with mineral trioxide aggregate (MTA) was performed under local anaesthesia to induce a mineralized barrier at the exposed surface. Teeth were extracted from patients after 7, 14 and 35 days. Sections of the extracted teeth were prepared and stained for various markers using indirect immunofluorescence. Fibrocytes were counted, and the data were statistically evaluated using the Dunnett test. RESULTS: In uninflammed pulp tissue, a pro-collagen I-positive reaction was detected in odontoblasts, as well as in perivascular cells. Most of the CD45-positive cells were negative for pro-collagen I in normal pulp tissue, whereas CD45+/pro-collagen I+ fibrocytes were detected 7 days after injury. At day 14, fibrocytes were recognized under the fibrous matrix in contact with MTA and had infiltrated into regions of new capillary formation, where the fibrocytes were positively stained for vascular endothelial growth factor. By 35 days, fibrocytes were few, coincident with the formation of dentine bridges. The number of fibrocytes peaked 7 days post-injury and decreased at 14 days. CONCLUSIONS: The presence of fibrocytes in human pulp wound healing was observed. The spatiotemporal distribution of fibrocytes suggests that fibrocytes are involved in the early stages of pulp wound healing, specifically by contributing to new blood vessel formation.


Assuntos
Medula Óssea/patologia , Células do Tecido Conjuntivo/patologia , Polpa Dentária/patologia , Adolescente , Adulto , Compostos de Alumínio/farmacologia , Compostos de Alumínio/uso terapêutico , Calcificação Fisiológica , Compostos de Cálcio/farmacologia , Compostos de Cálcio/uso terapêutico , Polpa Dentária/efeitos dos fármacos , Polpa Dentária/lesões , Capeamento da Polpa Dentária/métodos , Exposição da Polpa Dentária/terapia , Combinação de Medicamentos , Humanos , Odontoblastos/efeitos dos fármacos , Odontoblastos/patologia , Óxidos/farmacologia , Óxidos/uso terapêutico , Agentes de Capeamento da Polpa Dentária e Pulpectomia/farmacologia , Agentes de Capeamento da Polpa Dentária e Pulpectomia/uso terapêutico , Silicatos/farmacologia , Silicatos/uso terapêutico , Fator A de Crescimento do Endotélio Vascular , Cicatrização/fisiologia , Adulto Jovem
16.
Compend Contin Educ Dent ; 39(3): 182-189, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29493248

RESUMO

Among the goals of pulp capping are to manage bacteria, arrest caries progression, stimulate pulp cells to form new dentin, and produce a durable seal that protects the pulp complex. This article will provide a general discussion of direct and indirect pulp capping procedures, offering practitioners a pragmatic and science-based clinical protocol for treatment of vital pulp exposures. A clinical case will be presented in which a novel light-cured resin-modified mineral trioxide aggregate hybrid material was used to manage a mechanical vital pulp exposure that occurred during deep caries excavation.


Assuntos
Materiais Dentários/química , Materiais Dentários/farmacologia , Capeamento da Polpa Dentária/métodos , Capeamento da Polpa Dentária/tendências , Agentes de Capeamento da Polpa Dentária e Pulpectomia/química , Agentes de Capeamento da Polpa Dentária e Pulpectomia/farmacologia , Compostos de Alumínio/química , Compostos de Alumínio/farmacologia , Compostos de Alumínio/uso terapêutico , Bactérias/efeitos dos fármacos , Compostos de Cálcio/química , Compostos de Cálcio/farmacologia , Compostos de Cálcio/uso terapêutico , Cárie Dentária/terapia , Polpa Dentária/efeitos dos fármacos , Capeamento da Polpa Dentária/normas , Exposição da Polpa Dentária/terapia , Restauração Dentária Permanente/métodos , Dentina/efeitos dos fármacos , Combinação de Medicamentos , Humanos , Óxidos/química , Óxidos/farmacologia , Óxidos/uso terapêutico , Agentes de Capeamento da Polpa Dentária e Pulpectomia/uso terapêutico , Silicatos/química , Silicatos/farmacologia , Silicatos/uso terapêutico
17.
Clin Oral Investig ; 22(8): 2879-2887, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29435662

RESUMO

OBJECTIVES: We evaluated a novel micro-computed tomography (micro-CT) assessment for quality and quantity of dentin repair, which is difficult to visualize by histological analysis, after direct pulp capping under standardized cavity preparation. MATERIALS AND METHODS: Standardized cavities were prepared on Wistar rats and direct pulp capping was performed using two commercial bioceramics, ProRoot MTA, and iRoot BP Plus. After 2 or 4 weeks, quality and quantity of tertiary dentin formation were evaluated using high-resolution micro-CT analyses including dentin mineral density, dentin mineral contents, compactness and integrity of tertiary dentin, and dentin volume with/without void space. Reproducibility of micro-CT analyses was confirmed by histological evaluation of the same specimen. RESULTS: The exposed pulp area sizes were similar between iRoot BP Plus and ProRoot MTA. Micro-CT analysis of 2-week samples showing compactness of tertiary dentin was significantly higher in iRoot BP Plus than ProRoot MTA (p < 0.05). Tertiary dentin volume without void space, dentin mineral contents, and density were not significantly different between the groups. In 4-week samples, a significant increase was observed in dentin mineral density, compactness, and dentin volume with/without void space induced by iRoot BP Plus (p < 0.05). Micro-CT analysis of tertiary dentin integrity demonstrated that some ProRoot MTA specimens had small defects and lacked continuity (6/512 images). No defects were observed with iRoot BP Plus. CONCLUSIONS: Micro-CT analysis was confirmed as an accurate, objective, and inclusive approach for evaluating quality and quantity of dentin repair. CLINICAL RELEVANCE: These multifaceted approaches to evaluate pulp capping materials may accelerate review processes, ultimately improving vital pulp therapy.


Assuntos
Capeamento da Polpa Dentária/métodos , Dentina/diagnóstico por imagem , Agentes de Capeamento da Polpa Dentária e Pulpectomia/farmacologia , Microtomografia por Raio-X/métodos , Animais , Dentina/química , Ratos , Ratos Wistar , Reprodutibilidade dos Testes , Materiais Restauradores do Canal Radicular , Silicatos
18.
J Appl Oral Sci ; 26: e20160629, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29412365

RESUMO

The aim of the study was to evaluate the effects of the capping materials mineral trioxide aggregate (MTA), calcium hydroxide (CH) and BiodentineTM (BD) on stem cells from human exfoliated deciduous teeth (SHED) in vitro. SHED were cultured for 1 - 7 days in medium conditioned by incubation with MTA, BD or CH (1 mg/mL), and tested for viability (MTT assay) and proliferation (SRB assay). Also, the migration of serum-starved SHED towards conditioned media was assayed in companion plates, with 8 µm-pore-sized membranes, for 24 h. Gene expression of dentin matrix protein-1 (DMP-1) was evaluated by reverse-transcription polymerase chain reaction. Regular culture medium with 10% FBS (without conditioning) and culture medium supplemented with 20% FBS were used as controls. MTA, CH and BD conditioned media maintained cell viability and allowed continuous SHED proliferation, with CH conditioned medium causing the highest positive effect on proliferation at the end of the treatment period (compared with BD and MTA) (p<0.05). In contrast, we observed increased SHED migration towards BD and MTA conditioned media (compared with CH) (p<0.05). A greater amount of DMP-1 gene was expressed in MTA group compared with the other groups from day 7 up to day 21. Our results show that the three capping materials are biocompatible, maintain viability and stimulate proliferation, migration and differentiation in a key dental stem cell population.


Assuntos
Compostos de Alumínio/farmacologia , Compostos de Cálcio/farmacologia , Hidróxido de Cálcio/farmacologia , Óxidos/farmacologia , Agentes de Capeamento da Polpa Dentária e Pulpectomia/farmacologia , Silicatos/farmacologia , Células-Tronco/efeitos dos fármacos , Dente Decíduo/citologia , Análise de Variância , Diferenciação Celular/efeitos dos fármacos , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Capeamento da Polpa Dentária/métodos , Combinação de Medicamentos , Proteínas da Matriz Extracelular/análise , Gliceraldeído-3-Fosfato Desidrogenases/efeitos dos fármacos , Humanos , Teste de Materiais , Fosfoproteínas/análise , Reprodutibilidade dos Testes , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Células-Tronco/fisiologia , Fatores de Tempo , Dente Decíduo/efeitos dos fármacos
19.
J Endod ; 44(4): 529-535, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29397215

RESUMO

INTRODUCTION: Vital pulp therapy (VPT) is a biological approach to minimally invasive endodontics. This randomized clinical trial aimed to evaluate and compare clinical and radiographic success of 4 VPTs (indirect pulp capping [IPC], direct pulp capping [DPC], miniature pulpotomy [MP], and full pulpotomy [FP]) using calcium-enriched mixture cement for deep caries management of mature permanent molars including teeth with clinical signs of irreversible pulpitis and the presence of apical periodontitis. METHODS: Blinded participants (N = 302) were randomly allocated to 4 study arms. Random allocation was disregarded when visible pulp exposures did not happen after complete caries removal and the tooth was transferred to the IPC arm. Pre- and intraoperative data including vitality test results, pulpal/periapical status, and exposure type/location were recorded. Pain was measured using a numeric rating scale before treatment initiation up to 1 week postoperatively. Participants were followed up for 1 year. RESULTS: The groups were homogenous in terms of age, sex, marital status, education, and practitioner; pre- and intraoperative conditions were similar in all arms and did not affect the long-term success. Preoperative pain and apical periodontitis were significantly different among arms (P < .05); however, it was not the case when the IPC group was excluded. After baseline pain adjustment, pain relief was continuous with similar patterns in all treatment groups. The 3- and 12-month success rates of the VPT techniques were comparable in the IPC (98.7% and 100%, respectively), DPC (98.4% and 94.7%, respectively), MP (98.4% and 91.4%, respectively), and FP (93.5% and 95.5%, respectively) arms, respectively (P > .05). CONCLUSIONS: In deep caries management of mature permanent molars, the 4 VPTs were associated with favorable/comparable clinical and radiographic outcomes. The pulpal and periapical status as well as pulpal exposure type/location had no effect on treatment outcomes.


Assuntos
Capeamento da Polpa Dentária/métodos , Dente Molar/cirurgia , Pulpotomia/métodos , Adulto , Compostos de Cálcio/uso terapêutico , Cimentos Dentários/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Masculino , Óxidos/uso terapêutico , Periodontite Periapical/cirurgia , Compostos de Fósforo/uso terapêutico , Pulpite/cirurgia , Silicatos/uso terapêutico , Resultado do Tratamento
20.
J Endod ; 44(4): 585-591, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29397219

RESUMO

INTRODUCTION: Up-regulation of odontogenic differentiation, dentin formation, and angiogenesis in dental pulp are key factors in vital pulp therapy. The aim of this study was to investigate whether leptin could promote odontogenic differentiation and angiogenesis in human dental pulp cells (hDPCs). In addition, the involvement of the intracellular signaling pathway in these effects was determined. METHODS: The viability of hDPCs treated with leptin was examined using the water soluble tetrazolium salt-1 assay. Real-time polymerase chain reaction was performed to determine messenger RNA (mRNA) expression levels of odontogenic and angiogenic markers. Western blot analysis was used to measure odontogenic and angiogenic protein expression levels and assess mitogen-activated protein kinase (MAPK) pathway involvement. Alkaline phosphatase (ALP) and alizarin red staining were used to evaluate expression levels of ALP and calcified nodule formation after treatment with leptin and/or the presence of MAPK inhibitors. RESULTS: All concentrations of leptin used in this study did not significantly affect the viability of hDPCs. However, mRNA and protein levels of odontogenic and angiogenic markers, ALP activity, and calcified nodule formation were significantly increased in the leptin-treated group compared with those in the control group. Leptin enhanced phosphorylation of extracellular signal-related kinases, c-Jun N-terminal kinase, and p38 mitogen-activated protein kinases within 5 minutes after treatment. However, leptin-induced dentin sialophosphoprotein and vascular endothelial growth factor protein expression and mineralization were appreciably blocked by the presence of MAPK inhibitors. CONCLUSIONS: Leptin can induce angiogenesis, odontogenic differentiation, and mineralization in hDPCs via activating the MAPK signaling pathway.


Assuntos
Polpa Dentária/citologia , Leptina/farmacologia , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Neovascularização Fisiológica/efeitos dos fármacos , Odontogênese/efeitos dos fármacos , Adulto , Western Blotting , Diferenciação Celular/efeitos dos fármacos , Polpa Dentária/irrigação sanguínea , Polpa Dentária/crescimento & desenvolvimento , Capeamento da Polpa Dentária/métodos , Humanos , Reação em Cadeia da Polimerase em Tempo Real , Adulto Jovem
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